A 27-year-old woman comes to the office to discuss weight loss. She has gradually gained weight since she was married 6 years ago. The patient says, "I have tried every diet I know, and nothing seems to work. There must be something wrong with me." Medical history is unremarkable. She has 2 children and does not use tobacco or alcohol. Vital signs are within normal limits. BMI is 28 kg/m². Physical examination shows an overweight body habitus and is otherwise normal. Which of the following is the most appropriate response to this patient's concerns?

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11ec25c8_d2cc_d989_bc81_29c5f650ac13_MD0003_00 This patient is overweight (ie, BMI 25-29.9 kg/m²) and has been gradually gaining weight over the years. During this time, she has been unsuccessful in losing weight using various diet programs. A number of weight-loss diet programs (eg, low-fat, low-carbohydrate, blended low-calorie) have proved to be effective in clinical trials, but application by individual patients is commonly met with inconsistent success. ² Regardless of the specific diet chosen, successful weight loss can be enhanced by incorporating behavioral strategies into the overall program. In particular, detailed self-monitoring of dietary intake, exercise, and daily weight is associated with increased success rates. Self-monitoring is also associated with greater long-term maintenance of weight loss. Although some patients fear that daily weighings may lead to frustration and less weight loss, most studies have not found this effect in practice. (Choice A) Overweight and obese (BMI ≥30 kg/m²) patients commonly experience weight gain beginning in their 20s, regardless of marital status or childbearing. Although this patient's weight gain began after marriage, there is otherwise no indication that family stress is the cause of it. ² (Choice B) Exercise should be included in a broader weight loss program because it is associated with greater weight loss and better long-term maintenance. However, exercise alone is not generally effective for weight loss. (Choice D) Weight-loss medications are recommended for patients in whom conservative measures have failed and whose BMI is ≥30 kg/m² or ≥27 kg/m² with additional weight-related conditions (eg, diabetes mellitus). However, the costs and potential adverse effects of these medications are not typically justified for otherwise healthy, overweight patients. (Choice E) Screening for secondary causes of weight gain (eg, hypothyroidism) and weight-related complications (eg, diabetes mellitus, hyperlipidemia) should be considered for overweight and obese patients. However, most overweight patients have normal thyroid function and should not be given false hope that they have an easily correctable condition in the absence of additional clinical signs. Educational objective: Successful weight loss can be enhanced by incorporating behavioral strategies into the overall program. Detailed self-monitoring of dietary intake, exercise, and daily weight is associated with increased success rates. Self-monitoring is also associated with greater long-term maintenance of weight loss. References: What matters in weight loss? An in-depth analysis of self-monitoring. (http://www.ncbi.nlm.nih.gov/pubmed/28500022) Log often, lose more: electronic dietary self-monitoring for weight loss. (http://www.ncbi.nlm.nih.gov/pubmed/30801989)

A 27-Year-Old Woman Comes to the Office to Discuss Weight